HealthCare.gov Back On Track?

This is TELL ME MORE from NPR News. I'm Michel Martin. Coming up, activists marked World AIDS Day this weekend. We will hear from a religious leader who's bringing HIV prevention into the pulpit. That's in just a few minutes. But first, speaking of health, we want to get a progress report on HealthCare.gov. That's the website created under the Affordable Care Act that's supposed to help Americans purchase health insurance. But as most people probably know by now, the October launch was rife with confusion and glitches. In November, President Obama apologized for all this and also made a promise.

(SOUNDBITE OF SPEECH)

PRESIDENT BARACK OBAMA: The website will work much better on November 30, December 1 than it worked certainly on October 1. That's a pretty low bar. It'll be working a lot better than it is - it was last week and will be working better than it was this week, which means that the majority of people who go to the website will see a website that is working the way it's supposed to.

MARTIN: Now that that deadline has come, we wanted to check back in with Mary Agnes Carey. She's a senior correspondent at Kaiser Health News. That's a news service. It's not affiliated with Kaiser Permanente. And she's been with us throughout the debate and implementation of the Affordable Care Act trying to help guide us through it. Welcome back. Thanks for joining us once again. Happy Thanksgiving to you.

MARY AGNES CAREY: Same to you.

MARTIN: So the $64,000 question, how is HealthCare.gov performing now?

CAREY: Well, federal officials said yesterday they've made many, many improvements and that it's going to work for the vast majority of users. They say up to 50,000 people could be on at any one time. This was the traffic they originally envisioned - up to 800,000 people a day. They talked about software improvements, hardware improvements. Instead of one online ramp to get into the site, they now have four. And so they say there will still be some problems, and some people will have some issues. Some may prefer paper or the phone call, or they may simply have problems with the website. But they say things are much, much better.

MARTIN: Now we know that many people tried to use HealthCare.gov in October when the exchanges first opened. We know that many people were discouraged by problems with the system. Do we have any idea what these potential customers are doing? Do we know that they're trying again, whether they've given up? Is the administration doing something to try to woo people back in to try it again?

CAREY: Part of the account creation function that created such a problem when the site was launched, part of that was done to create a way to get back to people. And so the administration has said they're making it a priority to reach out to people who had problems signing up to get back to them to encourage them to come back. And also, as we know, there's a lot of news reports today talking about the improved capabilities of HealthCare.gov. That in itself may inspire people to go back. But we've got to remember, now the test is, can it handle 50,000 people at one time? They say it's built for that. What if they get more than that? Can the system handle it if the demand increases because folks have until December 23 to enroll for coverage starting on the first?

MARTIN: I was going to ask you about that. But hold that thought for just a minute. But how exactly are they trying to get back to people? I mean, is it like, you know, when the airline cancels or delays your flight, you get a call back if you've signed up for that? Is that how it's going to be? Is President Obama's voice going to say, hey, call me back?

CAREY: I think, you know, you'll get - probably most of it would be done through email. There may or may not be a telephone contact. But if they have your email address, you're going to get a message saying please come back and try again.

MARTIN: What do we know about how many people have signed up through HealthCare.gov now? And how does that figure measure up against what the administration was hoping?

CAREY: As of November the 2 - these were numbers released in the middle of November - there were about 106,000 people who had signed up, had picked a plan, but three-quarters of those were through the state exchanges. In about 14 states, in the District of Columbia, those states in the district are running their own exchanges. So it was only a quarter of that 106,000 number was through the federal exchange. It was dismal. They knew it would be that way. Official numbers will come out again in the middle of this month, and they're hoping that they will be improved. But since these improvements were just made, really, beginning - you know, the target was November the 30 - those December numbers may not be so hot either.

MARTIN: Now remember - and word came just before Thanksgiving that the administration is delaying the deadline for small businesses to shop for coverage on HealthCare.gov. What does that mean?

CAREY: That means that they'll have to go - many businesses now buy health insurance through a broker, through a health insurance agent or through the insurance company directly. They'll continue to do that. They delayed the online enrollment for a year, in part, because they've had so many problems with the consumer part of HealthCare.gov, they really wanted to focus their resources there.

MARTIN: So what does this mean, though, for the big picture? I mean, isn't there a target number of people who have to participate for the program to be sustainable? So what does this mean?

CAREY: The Congressional Budget Office has said they've estimated 7 million people will enroll by the end of March. And of that number, the estimates have been - they want something like 2.7 million to be younger healthier folks to get in because they help balance out the risk pool. So right now, the numbers are not looking too good. But as we know, the administration has said you can enroll until March 31 and not face the individual mandate penalty, this penalty that most people have insurance or pay a fine.

And so that gives people to the end of March. What will the numbers be not only in December, but January and February and even March facing a March 31 deadline? So the numbers may continue to grow to help hit that 7 million, or they may not. But I think the bigger issue is, of the people that do enroll by the end of March, what's the mix? Do you have the younger healthier people? What sort of rates are those people paying? What's the risk pool look like no matter what the number? That's key to defining the success or failure of the law at that point.

MARTIN: Now could you walk us again through the important dates that are coming up now. And if you're driving, please do not get a pencil and write this down. This will be on our website, you know. But just walk us through it, OK. You'd mentioned one important date is December 23. What is that date? And are there other important dates coming up?

CAREY: Sure. If you would like to have coverage starting on January the 1 through either your state exchange - if they're operating one - or the federal exchange - HealthCare.gov - you need to sign up by December 23 for coverage. You need to pay for that coverage by December 31 for it to begin on January 1. Those are key deadlines. Now let's say your current health insurance doesn't expire until beyond January 1, you have until March 31 to sign up for health insurance and not face that penalty. But one thing you need to know is most health insurers start their coverage on the first of the month, and they need a few weeks to process. So if you want coverage beginning the first of April, for example, you better be signed up by mid-March to make that happen.

MARTIN: And if there are tax credits, if you are part of the portion of the population that is eligible for a subsidy, does that kick in right away? How does that work?

CAREY: That can - one of two things. You can have it paid to the insurance company and lower your premium so you pay less out of your pocket, or you could pay the full amount of the premium and reconcile that at tax time. That's for individuals - that would work. And I just want to say, small businesses do get tax credits as well.

MARTIN: OK. Or maybe Santa could put it in your stocking. But - and at the time of his - this is a final thought here - President Obama proposed a workaround for those who were cut from their individual care plans. Now this is not a huge number of people. For the people that it does affect, it was a very upsetting situation. It got a lot of attention certainly from the media. What's the status of that?

CAREY: Well, these are folks in the individual market. It's about 14 million people - about 5 percent of those who are enrolled. And what the president said was, if it was OK with a state insurance commissioner - and they had that kind of clout over insurers in their states - and OK with the insurers, they could continue to offer those policies for another year. So that process is unfolding. Some insurers have said they'll do it. Some have said no. Some insurance commissioners have said no, they don't want the policies to be renewed for a year. Some have said yes. That's shaking out with consumers, but at least the option's out there if insurers want to do it and insurance commissioners want to do it.

MARTIN: Mary Agnes Carey's a senior correspondent with Kaiser Health News. She's been joining us from time to time to help us - walk us through some of the details of the Affordable Care Act. And she was with us once again in our Washington, D.C. studios. Mary Agnes Carey, thank you so much for joining us once again.